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Public health physicians, Social Inequalities in Health and Infectious Disease Control

Public health physicians, Social Inequalities in Health and Infectious Disease Control. Terry-Nan Tannenbaum Public Health Department Agence de la santé et des services sociaux de Montréal PHPC CPD Session, 9 June 2013. Background. Infectious disease control

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Public health physicians, Social Inequalities in Health and Infectious Disease Control

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  1. Public health physicians, Social Inequalities in Health and Infectious Disease Control Terry-Nan Tannenbaum Public Health Department Agencede la santé et des services sociaux de Montréal PHPC CPD Session, 9 June 2013

  2. Background • Infectious disease control • Basic public health function • Protection: case investigations, outbreak control • Prevention/promotion: vaccination, disease prevention activities • Staff not always aware of importance of social inequalities in effectiveness of public health measures

  3. Objective of presentation • How can staff use equity lens when planning and carrying out prevention/promotion activities • Share Montreal experience and learn what others are doing

  4. Montreal experience • Knowledge of social inequalities in health (SIH) in infectious disease control (IDC) low • Little data on importance of social determinants in disease occurrence • Little knowledge and capacity to design programs to reduce SIH • “Gut feeling”: most important factors are cultural community, literacy level, recent immigration, presence of factors such as homelessness

  5. First efforts • Needed data to understand importance of social factors in disease occurrence • Chose one area of IDC to develop interventions: vaccination coverage

  6. Income

  7. Education

  8. Ecologicanalysis of the determinants of 9 Reportable Diseases Source: Allard R, Steet MC, LeGuerrier P, Jochem K. Analyseécologique des déterminants des MADO, DSP, Agence de Montréal, 2013

  9. Indicators of social inequalityassociatedwith certain reportable diseases • Households of 6 persons or more • Educationallevel • Occupationalstatus • Income • Population measuresobservedatlevel of RTA, but not necessarilyatindividuallevel Source: Allard R, Steet MC, LeGuerrier P, Jochem K., Analyseécologique des déterminants des MADO, DSP, Agence de Montréal, 2013

  10. Incidence of shigella by FSA, Montreal2004-2008 Associated with higher proportion of households with 6 persons or more, certain cultural groups

  11. Incidence of infectious syphilis by FSA Montréal, 2004-2008 Associated with income level, larger households certain cultural groups and lower employment activity

  12. Vaccination rates • No vaccine registry, data on coverage by territory incomplete • School vaccination only available indicator • Vaccination coverage of HPV (4thgrade) • Measles vaccination campaign in 2010

  13. Measles coverage by CSSS Territory Source: Kaiser D. Couverturevaccinalecontre la rougeole en milieu scolaire, DSP Agence de Montréal, 2013

  14. Measles coverage by type of school Source: Kaiser D. Couverturevaccinalecontre la rougeole en milieu scolaire, DSP Agence de Montréal, 2013

  15. HPV Coverage rates by school, Montreal, 2010 - 2011

  16. Proposed indicators for infectious disease monitoring • Rates of HIV, Chlamydia, TB, Influenza and pneumococcal vaccination – recommended • Rates of gonorrhea, syphilis, basic immunisation coverage, invasive pneumoccal disease – possible indicators Source: MasséR, Raynault MF. Indicateurs de surveillance pour les ISS en maladies infectieuses. Décembre 2011

  17. Where we are: Public Health Department • Small central unit to coordinate projects and support teams • Other teams each chose one area to examine: • Occupational health: do programs reach vulnerable populations (agency workers) • Preventive practices: do programs account for literacy issues • Maternal and child health: how to address equity in program to reduce time spent in front of screens

  18. Where we are: Health Protection Team • Use of indicators • Available data inadequate to guide or evaluate interventions • Data that is available doesn’t necessarily coincide with gut feeling • Need to develop indicators that are available and robust to help develop programs • Other possible actions • Apply health equity lens to health promotion/health prevention activities • Examples: prevention of enteric diseases, vaccination promotion

  19. Acknowledgements • Health protection sector, Public HealthDepartment, Agence de la santé et des services sociaux de Montréal • Marie-France Raynault, Public HealthDepartment, Agence de la santé et des services sociaux de Montréal

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